NEW PARTS: FEWER GET NEW SHOULDERS, BUT RESULTS CAN PUT THEM BACK IN THE GAME

May 1, 2012 – Jack Sirard contributing writer

When it comes to needing two strong shoulders for work or play, Tom Salb III is the man to talk to.

He’s an executive with a general contractor in the Washington, D.C., area who loves the game of senior softball.

“I come from a background of hard work and lifting weights and by the time I was age 54, the arthritis in my shoulders was so bad that I couldn’t do anything. The shoulder joints were worn out,” he says.

As a result, Salb has had shoulder replacement surgery on both shoulders in two separate operations.

He’s among a growing number of seniors who have opted to have shoulder, hip and knee replacement surgery in recent years and most, but certainly not all, have enjoyed a much greater quality of life in the ensuing years.

Salb had his right shoulder replaced two years ago at age 54. “At the time, I could not throw overhand and my bench press was about 45 pounds. Now I’m 100 percent recovered and can throw the ball great. My bench press 23 months after the 5.5-hour surgery is up to 285 pounds,” he says.

Salb, who plays the outfield for Pill and Pill out of West Virginia and Joe B’s in Maryland, says that following the second surgery this past fall, he’s in tip-top condition. “I usually play three times a week and get to one or two tournaments a month. Since I still run exceptionally well, I really like to get out there and play.”

He notes that both surgeries were similar and while he stayed in the hospital for two days the first time, he was only in for a day with the second surgery. “The second time at age 57, I did a lot more stretching as part of the recovery and as a result I was playing softball a lot faster again.”

Dr. Fred Khasigan, an orthopedic surgeon in Sacramento, reports that knee replacement surgery is the most popular of these types of surgeries.

“We are doing seven knees for every hip replacement surgery and shoulders are even less.”

“We are able to do much more precise work than we were years ago…MRI and CT scans allow us to make precise movements in our surgery. The recovery process is now down to spending a day or two in the hospital where we get them up quickly.”

He notes that the total shoulder surgery is not as common. “But the breakthroughs that we have seen means that with this surgery long-term problems can be alleviated,” Khasigan says.

What about the risks?

The Sacramento-area surgeon says that “there is always a risk of infection or post-op blood clots, but we have treatments for them and the complications are really less than 2 percent. We often say that the operation is 95 percent successful, but in reality it is even higher than that.”

“While the surgery for knee, hip or shoulder replacement is very successful, we never do it unless it is absolutely necessary. You need to know that with the risk only being 2 percent or less, if it’s you, it’s 100 percent.

“So if you get an infection, it can be a quite involved process to get over it…sometimes as long as four to six months. That’s why we don’t do it for everyone who walks in the door.”

The American Academy of Orthopaedic Surgeons points out that “every year, thousands of conventional total shoulder replacements are successfully done in the United States for patients with shoulder arthritis.

This type of surgery, however, is not as beneficial for patients with large rotator cuff tears who have developed a complex type of shoulder arthritis called cuff tear arthropathy. For these patients, conventional total shoulder replacement may result in pain and limited motion, and reverse total shoulder replacement may be an option.”

The AAOS reports that a conventional shoulder replacement device mimics the normal anatomy of the shoulder: a plastic "cup" is fitted into the shoulder socket (glenoid), and a metal "ball" is attached to the top of the upper arm bone (humerus). In a reverse total shoulder replacement, the socket and metal ball are switched. The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus.

The AAOS adds that a reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm. In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion. A conventional replacement device also uses the rotator cuff muscles to function properly.

In a patient with a large rotator cuff tear and cuff tear arthropathy, these muscles no longer function. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm.

This AAOS says that the procedure to replace a shoulder joint with an artificial device usually takes about two hours. The surgeon will make an incision either on the front or the top of your shoulder. He or she will remove the damaged bone and then position the new components to restore function to the shoulder.

The Academy points out that reverse total shoulder replacement may be recommended if you have:

• A completely torn rotator cuff that cannot be repaired.

• Cuff tear arthropathy.

• A previous shoulder replacement that was unsuccessful.

• Severe shoulder pain and difficulty lifting your arm away from your side or over your head.

• Tried other treatments, such as rest, medications, cortisone injections, and physical therapy, that have not relieved shoulder pain.

Make no mistake about it. Reverse total shoulder replacement is a highly technical procedure. You should fully discuss all aspect of the surgery with your doctor.

The AAOS notes that the risks for any surgery include bleeding and infection. Complications specific to a total joint replacement include wear, loosening, or dislocation of the components. If any of these occur, the new shoulder joint may need to be revised, or re-operated on.